Nutritional Screening in Older Adults First Results from WP2 of the - - PowerPoint PPT Presentation

Nutritional Screening in Older Adults

First Results from WP2 of the MaNuEL project

Lauren Power, University College Dublin, Ireland On behalf of the MaNuEL consortium

CONFLICT OF INTEREST DISCLOSURE

I have no potential conflict of interest to report

What is Malnutrition Screening?

Examples of Screening Programmes

Cervical Cancer

Pap smear test HPV test Visual inspection

Breast Cancer

Mammogram test Clinical exam

Prostate Cancer

DRE test PSA test

Quick Simple Valid

Principles of good screening practice

Principles of Effective Screening Programmes

The Condition

Should be a public health problem Incidence, prevalence and natural history known

The Screening Programme

Simple and safe Precise, valid and reliable Cost-effective Cut-off levels defined and agreed Acceptable to the target population Agreement on further diagnostic investigation Strong evidence base Chosen based on setting, local resources and practicability Certain parameters should have adaptions for the elderly population e.g. BMI Can be conducted by a multi-disciplinary team

Intervention

An appropriate follow-on plan should be agreed Follow-on plan should be acceptable and effective

Wilson and Jungner 1968 Precise, valid and reliable Cost-effective Strong Evidence Base Chosen based on setting, practicability

Malnutrition Screening is…

..a quick and easy procedure using a validated nutritional screening tool (NST), designed to identify those who are at risk of malnutrition and may benefit from nutritional intervention by a nutritionally trained professional

(ESPEN 2002)

Malnutrition Screening

Community Rehabilitation Institutions Hospital

• Questionnaires
• Biochemical measures

Quick Simple Valid

• Anthropometrics
• Subjective measurements

(physical function/ social/ cognitive function)

Why are we concerned about nutritional screening? ½ hospital wards screen for malnutrition risk

Schindler K. et al. (2010) Clinical Nutrition

21% screened with validated NST

Eglseer D. et al. (2017) Nutrition

30% increase in identification of malnutrition

• Improves malnourished patients nutritional status
• Reduced length of hospital stay

Kruizenga H.M. et al. (2005) American Journal of Clinical Nutrition

€2 per patient on admission

Barriers Organisational culture Competing priorities The value of clinical judgement Training and Education Discrepancy between attitudes and practice

Green et al. (2013) Journal of Human Nutrition and Dietetics

Why should we treat nutritional screening differently in

• lder adults?

Nutritional concerns in adults Reduced Dietary Intake Disease- Related Malnutrition Protein-Energy Malnutrition Nutritional concerns in older adults: Many are inevitable

↓ Bone Mineral Density ↓ Immune Function ↓ Vitamin Absorption ↓ Gastric Mobility ↓ Muscle Mass

↑ Oxidative

Stress Physiological Concerns Malnutrition Risk

Why should we treat nutritional screening differently in older adults?

Hospitalisation

Poverty

Mobility Poly- pharmacy

Cognitive Impairment

Many other determinants of malnutrition risk in older adults Not enough to assess anthropometrics alone in this group BMI 18.5 kg/m2 - consistently found to be an unreliable in

• lder populations

Malnutrition

Nutritional screening tools validated in

• lder adults

Mini Nutritional Assessment (Short Form) Malnutrition Universal Screening Tool (MUST)

Both recommended by ESPEN 

MaNuEL Work Package 2

“Malnutrition screening in

• lder adults”

Work Package Aim: To create an overview of existing tools for malnutrition for older adults

________________________________________

Work Package Objectives:

• Literature review on tools validated in older adults
• Creation of a database of tools used in older adults
• Creation of a scoring system to rate tools
• Devise recommendations on the best screening tools for use

with older adults

Tools validated in older adults (no. studies) 34 (n=97) Community 19 (n=32)

African NST (n=1) Ayrshire NST (n=1) CNAQ (n=1) DETERMINE (n=5) ENS (n=1) GNRI (n=1) MI (n=1) MNA-SF-V1 (n=5) MNA-SF-V2 (n=3) MNA-self (n=1) MRST-C (n=1) MRST-H (n=1) MUST (n=2) NRAT (n=1) NUFFE (n=2) SCREEN (n=1) SCREEN II (n=2) SNAQ NL (n=1) SNAQ 65+ (n=1)

Rehabilitation 5 (n=6)

CNAQ (n=1) MNA-SF-V2 (n=1) MST (n=1) NUFFE (n=2) SNAQ US (n=1)

Institutions 11 (n=17)

African NST (n=1) CNAQ (n=1) Chinese CNS (n=2) DETERMINE (n=1) GNRI (n=1) MNA-SF-V1 (n=1) MNA-SF-V2 (n=3) MST (n=1) MUST (n=4) RS (n=1) SNAQ RC (n=1)

Hospital 22 (n=51)

Chandra NST (n=1) Chinese NST (n=1) Canadian NST (n=1) CONUT (n=3) CNAQ (n=1) EVS (n=1) GNRI (n=5) GMS (n=1) Icelandic NST (n=1) MEONF II (n=1) MNA-SF-V1 (n=8) MNA-SF V2 (n=1) MRST-H (n=2) MST (n=5) MUST (n=7) NRS-2002 (n=6) NUFFE (n=1) NNSA (n=1) NURAS (n=1) RS (n=1) SNAQ US (n=1) SNST (n=1)

Scoring System Criteria

Validated in the elderly Yes/No Type of Validity

• Construct
• Criterion
• Predictive

Validated Against MNA, SGA or clinical assessment Validation Results Se, Sp, k-values etc. Amount of validation studies Some are more suitable for an elderly population/are more practical measures than others Lower Score e.g.

• Albumin
• Calf Circumference

Higher Score e.g.

• Recent weight loss
• Reduced appetite

Adjustments for the Elderly Time 0-3 min 4-6 min 7-10 min Cost/access Free Not Free Used By

• Nutritionally trained staff only
• All staff

Languages English only English plus other EU languages

• 1. Validation
• 2. Parameters
• 3. Practicability
• Max. 15 points
• Max. 15 points
• Max. 15 points

3 equally weighted domains: max. 45 points

+ +

Hospital: Mini Nutritional Assessment Short Form (MNA-SF) Malnutrition Screening Tool (MST)

Community: DETERMINE Your Health Checklist

Rehabilitation: The Nutritional Form for the Elderly (NUFFE)

Institutions:

Short Nutritional Assessment Questionnaire Residential Care (SNAQRC)

Take Home Messages for Geriatric Medical Professionals

Malnutrition screening…

• is of utmost importance in older adults
• should be considered differently in older

people compared to the general adult population

• should be setting specific
• systems should be put in place in all healthcare

settings and prioritised

Acknowledgements

Prof Clare Corish Dr Marian A.E de van der Schueren Dr Eileen Gibney Dr Michelle Clarke Prof Jürgen Bauer Dr Susanne Leij-Halfwerk Ms Laura Bardon The MaNuEL consortium